NPIMap

Organization Active NPI

Memorial Hospital

Doing business as Knott County Family Healthcare West

  • Family Medicine Physician
  • Bulan, KY
National Provider Identifier
1376759563
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEMORIAL HOSPITAL
Doing business as
Knott County Family Healthcare West
Practice address
86 Savannah Lane
Bulan, KY 41722
Phone
(606) 598-5104
Fax
(606) 598-0983
NPI assigned
May 15, 2007
Last updated
Jan 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Benny Nolen
Title
Vice President
Phone
(606) 598-5104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

86 Savannah Lane
Bulan, KY 41722

Mailing address

509 Memorial Dr
Manchester, KY 40962-6195
Phone (606) 598-5104

Other identifiers 1

IdentifierTypeStateIssuer
APPLIEDOtherKYAPPLIED

Other names 1

  • Knott County Family Healthcare West Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041103001183 KY Part B Supplier - Clinic/Group Practice 4486616141 Receives reassigned benefits from 129 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pineville, KY; Somerset, KY; Oneida, KY; MC Kee, KY; Manchester, KY; London, KY; Corbin, KY; Beverly, KY

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1376759563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MEMORIAL DR",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409626195",
            "telephone_number": "606-598-5104",
            "fax_number": "606-598-0983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 SAVANNAH LANE",
            "city": "BULAN",
            "state": "KY",
            "postal_code": "41722",
            "telephone_number": "606-598-5104",
            "fax_number": "606-598-0983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "NOLEN",
        "authorized_official_first_name": "BENNY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "606-598-5104"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APPLIED",
            "identifier": "APPLIED",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Knott County Family Healthcare West",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Knott County Family Healthcare West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bulan, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.